UK PET Core Lab

Standard Operating Procedure

18F Image Quality Phantom

A procedure for filling and scanning the NEMA image quality phantom for submission to the UK
PET Core Lab based at the King’s College London & Guy’s and St. Thomas’ PET Centre for
accreditation purposes

Document Detail
Parent policy PET Centre Operational Policy
Document location //lemming.pet.kcl.ac.uk/ncri/ACTIVE_SOPs
Version 18F_Image_Quality_Phantom_SOP_PET_V3.2
Reviewed by Lucy Pike
Approved by PMarsden
Effective from Oct-2020
Date last reviewed Oct-2020
Date of next review Oct-2021
Owner PET Centre
Author Sorcha Curry
Superseded documents Image_Quality_Assessment_SOP_PET_V3.1
Related documents NEMA_Phantom_Analysis_SOP_PET
18F_NEMA_Phantom_Analysis_ER_PET
PET_QC_FORM_PET
Data_Management_SOP_PET
Keywords NEMA, Image Quality, 18F, phantom, site accreditation

Document History
Date Comments Approved by
10/10/2019 Original version LPike
29/10/2020 Annual Review PMarsden

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Contents
1 Introduction ............................................................................................................................. 3
2 Aim .......................................................................................................................................... 3
3 Roles and Responsibilities...................................................................................................... 3
4 Phantom Filling Procedure ..................................................................................................... 3
4.1 Preparation ..................................................................................................................... 3
4.1.1 Radionuclide Calibrator – 18F Factor .......................................................................... 3
4.1.2 NEMA IQ Phantom ..................................................................................................... 3
4.1.3 Scanner Clocks........................................................................................................... 3
4.2 NEMA Phantom Filling ................................................................................................... 4
4.3 NEMA Phantom Acquisition ........................................................................................... 6
4.4 NEMA Phantom Reconstructions ................................................................................... 6
4.5 NEMA IQ phantom SUV measurement .......................................................................... 7
4.6 Data Transfer ................................................................................................................. 7
5 Appendix A: NEMA Acquisition Form ..................................................................................... 8

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1 Introduction
This Standard Operating Procedure (SOP) applies to PET staff at local PET sites acquiring data
for the purposes of site accreditation by the UK PET Core Lab at King’s College London & Guy’s
and St Thomas’ PET Centre. Specifically, this procedure applies to the filling and acquisition of
the NEMA image quality phantom with 18F.

2 Aim
The purpose of this SOP is to provide instructions on filling and scanning the NEMA image quality
phantom with 18F to ensure consistent and accurate results for assessment of image quality and
quantitative accuracy.

3 Roles and Responsibilities

Staff at the local PET site are responsible for ensuring they have read the local rules, follow the
relevant systems of work and complete risk assessments as appropriate prior to starting any
phantom work.
Only persons trained in radiation safety for unsealed sources and competent at filling PET
phantoms should attempt this procedure. As filling the phantom involves the use of radioactivity,
appropriate radiation protection procedures of time, distance and shielding must be used at all
times. Users must also be familiar with the local department policies regarding use of radioactivity
– contact the local Radiation Protection Supervisor for advice. It is recommended that users
practice this procedure using water first to familiarise themselves with all the steps involved.

4 Phantom Filling Procedure

The steps in the following procedure are recommended to achieve the required spheres and
background activity concentrations at the time of scanning. Deviations to the phantom filling
protocol are allowed providing they result in the same activity concentrations. Where a different
procedure is followed please make sure the exact activities and volumes used for dilution are
recorded along with measurement times for decay correction.

4.1 Preparation

4.1.1 Radionuclide Calibrator – 18F Factor

Centres seeking UK PET Core Lab accreditation should have an 18F factor traceable to a
primary standard and the cross calibration for 18F on the PET scanner checked using a
uniform cylinder. The most recent results for the cross-calibration check should be recorded
in the NEMA acquisition form in appendix A.

4.1.2 NEMA IQ Phantom

The volume of the background compartment has been found to vary between phantom
designs. Where possible, please measure the volume for the phantom used (with the
spheres and lung insert inserted), and record on the NEMA acquisition form in appendix A.

4.1.3 Scanner Clocks

Before starting the procedure, make sure that the clock(s) used to record times is calibrated
to the scanner clock.

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4.2 NEMA Phantom Filling

The following instructions have been written for the Data Spectrum NEMA IEC body phantom set;
phantoms from other manufacturers are acceptable but as the design may vary users should refer
to the manufacturer’s instructions for filling.
Users should allow about 1 hour for filling the phantom plus 20 minutes scanning time. The PET
scan should be started 50 minutes after the activity in syringe 2 (background) is measured.

Equipment
§ Empty NEMA IEC PET Phantom with 6 empty spheres and lung insert (Figure 1)
§ Dose calibrator with traceable 18F factor
§ 2 x 2ml syringes
§ 2 x standard length, 21G or similar needles
§ Small plastic cup and funnel (if available)
§ Measuring jug or beaker (>500ml)
§ Stirrer
§ 2 x 60ml syringes
§ 2 x long, 22G or similar spinal needles (length ≥ 80mm)
§ Absorbent pads with plastic backing
§ ~100MBq 18F
§ Access to tap water
§ Clock or watch synchronised to the PET/CT scanner time
§ Appropriate personal protective equipment (PPE) for working with unsealed
radioactive sources: i.e. Film badge/finger TLDs, lab coat and disposable gloves.

Lung Insert

Phantom lid with

spheres attached

Filling screw

Figure 1: Picture of the NEMA IEC Image Quality Phantom (Data Spectrum)

1. Put on the appropriate PPE.

2. Prepare the work area by removing clutter and covering the surfaces with absorbent pads.
3. Unscrew the phantom lid with the spheres attached and remove from the main body of the
phantom.
4. Fill the phantom body to about ¼ with tap water or until just before the lung insert will float.
5. Secure the lid with the spheres attached onto the phantom body. The spheres should be
orientated as shown in Figure 2 with the 17mm and 37mm spheres aligned with the
horizontal axis of the phantom.

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6. Finish filling the background with water through the filling screw hole, leaving a large air
bubble for mixing the activity later. Ensure there are no leaks.
7. Remove the 6 sphere stopper screws from the lid.
8. Measure out 500ml of water into the measuring jug or beaker as accurately as possible,
ideally using weighing scales.

R L

Figure 2. Axial view of the NEMA IEC phantom

Spheres - Syringe 1: Aim to get 25kBq/ml in the spheres at the time of scanning:
9. Using a 2ml syringe draw up 17 ± 1 MBq 18F and label this syringe 1.
10. Measure syringe 1 in the radionuclide calibrator using the 18F factor and record the time and
the volume of tracer on the NEMA Acquisition Form (appendix A).
11. Place the syringe into a shielded area.

Background - Syringe 2: Aim to get 5kBq/ml in the background at the time of scanning:
12. Using a 2ml syringe draw up 70 ± 3 MBq 18F and label this syringe 2.
13. Measure syringe 2 in the radionuclide calibrator using the 18F factor and record the time (t0)
and the volume of tracer on the NEMA Acquisition Form (appendix A).
14. Place the syringe into a shielded area.
the PET scan should be started 50 minutes after t0
Syringe 1: Filling the Spheres:
15. Inject the contents of syringe 1 (17MBq) into the jug of water (500ml). Flush the syringe
several times to ensure all the activity is injected.
16. Measure the residual in syringe 1 in the radionuclide calibrator using the 18F factor and
record the time on the NEMA Acquisition Form (appendix A).
17. Stir the solution in the jug to homogenise being careful not to spill any.
18. Draw up a volume of the radioactive solution from the jug (spheres are ~50ml in total) into
a large syringe using a long needle.
19. Carefully insert the long needle into the filling tube of the largest sphere (it should reach into
the sphere itself).
20. Slowly inject the solution into the sphere being careful to remove any air bubbles.
21. Wipe off any excess solution from the top of the filling tube and screw in the stopper.
22. Repeat steps 18 to 21 for all remaining spheres working round from the smallest to the
largest spheres to ensure all are filled.

Syringe 2: Filling the Phantom background:

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23. Remove the background filling screw and inject the contents of syringe 2 (70MBq) into the
phantom background. Flush the syringe several times to ensure all the activity is injected.
24. Measure the residual in syringe 2 in the radionuclide calibrator using the 18F factor and
record the time on the NEMA Acquisition Form (appendix A).
25. Replace the filling screw and swirl/shake the solution in the phantom to homogenise the
solution.
26. Get the air bubbles in the phantom to travel to the side with the filling screw by tilting and
tapping the phantom.
27. Open the filling screw carefully to avoid spillage.
28. Use the cup and funnel to fill up the remainder of the phantom with water until almost full
(bend the cup to form a funnel if a funnel is not available)
29. Put the screw back in and shake/tap the phantom to get all air bubbles to the area with the
filling screw.
30. Open the filling screw carefully to avoid spillage.
31. Use a non-active syringe to fill up the remainder of the phantom so there are no air bubbles
32. Replace the filling screw.
33. Check the phantom carefully for leaks before transfer to the scanner.

4.3 NEMA Phantom Acquisition

the PET scan should be performed at 50 mins after t0
1. About 15 minutes prior to the PET scan, transfer the phantom to the scanning room using
a trolley to reduce radiation dose.
2. Place absorbent pads on the couch to prevent contamination.
3. Place the phantom on the couch on its side with the lid pointing orientated towards the foot
of the couch and away from the gantry.
4. Use the scanner positioning lasers to line up the phantom so the lung insert is level and
centralised in the gantry.
5. When setting up the patient demographics on the scanner enter the weight to be the same
value as the measured volume, and the injected activity as the total activity in the
background compartment (i.e. the contents of syringe 2) and the time this was measured –
also enter the residual activity measured if this is significant.
6. Perform the scout scan and make sure the scan will cover the entire phantom – One bed
position with the scan centred on the spheres should be sufficient (use the
contrast/brightness on the CT scout to check the sphere locations).
7. Perform the PET-CT scan following the routine clinical protocol for oncology patients.
a. If a weight-based protocol is normally used for clinical patients, please use the
parameters for a 70kg patient.
b. if the clinical protocol normally uses 2 minutes per bed position or less (equivalent
to 0.70mm/s for the mCT without TrueV or 1.10mm/s for the mCT with TrueV), please
also perform a 3 minute per bed position or equivalent acquisition immediately
after, and include it in the data sent to the Core Lab.
8. Record the acquisition times for the PET scans in appendix A.

4.4 NEMA Phantom Reconstructions

1. Reconstruct the PET and CT using your standard parameters for clinical oncology
patients, unless advised otherwise by the UK PET Core Lab.

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2. If the clinical protocol normally uses resolution recovery (e.g. SharpIR on GE scanners,
HDŸPET for Siemens) or Q.Clear please provide an additional reconstruction with this
option turned off.
3. Where available, please also provide PSF reconstruction – if not used routinely, the core
lab can provide suitable reconstruction parameters to use.

4.5 NEMA IQ phantom SUV measurement

1. Load the PET data into the viewing software used for local clinical review. Display the
corrected PET images in axial view, and navigate to a slice showing the spheres. Set the
viewing software to display values in activity concentration (i.e. Bq/ml).
2. Draw a VOI over the largest sphere and record the maximum activity concentration for
the whole sphere in the table below – please record all decimal places.
3. Draw a 5cm circular ROI in a slice that doesn’t contain the spheres or stalks (if the lung
insert was used, make sure it is not included in the ROI). Record the mean activity
concentration in the table below.

Largest sphere (record Background (record

Region
maximum value) mean value)
Activity Concentration

4.6 Data Transfer

1. Send the following data sets in original DICOM format – please make sure the private
header fields are kept intact during transfer from the scanner:
• Attenuation corrected PET (AC-PET) – standard clinical reconstruction
• Attenuation corrected PET (AC-PET) - without PSF (no resolution recovery or QClear)
• Non-attenuation corrected PET (NAC-PET)
• CT – please include the reconstruction used for clinical patient review
• Optional: Attenuation corrected PET (AC-PET) – with PSF, where available.

Scans can be transferred to the Core Lab electronically (please contact the Core Lab for
instructions), or burned to disc and mailed to:
Core Lab Physicists
UK PET Core Lab
PET Imaging Centre
1st Floor, Lambeth Wing
St Thomas’ Hospital
Westminster Bridge Road
London, SE1 7EH

Please include a completed copy of this document or email a copy to:

Email: pet-trials@kcl.ac.uk

Retain the raw PET data until accreditation is confirmed, in case additional reconstructions are
required by the Core Lab.

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5 Appendix A: NEMA Acquisition Form

Please complete the following fields:
PET Scanner Details

PET Centre Name:

Scanner Manufacturer &
Model:
Scanner Type: Fixed Mobile
Scanner ID:_____________
Date of Phantom Scan:
Name of Person Performing
the Phantom Acquisition:

Phantom Details
Phantom Manufacturer:
Phantom Background
Volume (ml):

Radionuclide Calibrator Details

Calibrator Make & Model:
18
F Factor used:
Date of most recent 18F
cross calibration check:
Results (measured/true
activity concentration):

18
F Activity Details
Spheres (aim 17 ± 1 MBq 18F):
Syringe 1 Activity (MBq):
Measurement Time (hh:mm:ss):

Dilution volume if not 500ml (ml)

Volume in Syringe (ml):
Residual Activity (MBq):

Measurement Time (hh:mm:ss):

Background (aim 70 ± 1 MBq 18F):

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Syringe 2 Activity (MBq):

Measurement Time (hh:mm:ss):
Volume in Syringe (ml):

Residual Activity (MBq):

Measurement Time (hh:mm:ss):

Phantom Acquisition Details

Acquisition 1:
Single static PET Acquisition start
time (hh:mm:ss):
Acquisition 2 (if applicable):
Single static 3min/bed PET
Acquisition start time (hh:mm:ss):

Phantom Reconstruction Details

Algorithm: Iterations:
Reconstruction 1 (clinical recon): Subsets: Post Filter:
Or Beta Value (QClear):

Reconstruction 2 (no PSF or Algorithm: Iterations:

Q.Clear applied): Subsets: Post Filter:

Algorithm: Iterations:
Reconstruction 3 (PSF or Q.Clear): Subsets: Post Filter:
Or Beta Value (QClear):

Phantom Quantitative Checks

kBq/ml measured for a 5cm ROI in

the uniform background
(should be accurate to within 5%)

Max kBq/ml measured for the

largest (37mm) sphere

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